Forum for Nordic Dermato-Venereology Nr2,2017 | Page 23
SPIRA Project
Holistic Aspects of Hidradenitis Suppurativa
in an Outpatient Clinic at Skåne University
Hospital
K arin B erggård , MD, P h D, senior consultant and
M eirav H olmdahl , MD, P h D, senior consultant
Department of Dermatology and Venereology, Skåne University Hospital,
SE-221 85 Lund, Sweden. E-mail: [email protected]
The SPIRA scholarship has been created by AbbVie to stimulate
new innovations for developing the caretaking process of patients
with hidradenitis suppurativa and psoriasis. Below is a report from
the award winners of 2017 on their work.
Hidradenitis suppurativa (HS) is a chronic inflammatory
skin disease characterized by recurring painful abscesses and
draining fistula, resulting in hypertrophic disfiguring scars.
The disease is primarily localized to the armpits, groin and
areas where skin rubs together. HS is more common in women,
overweight/obese patients and smokers. The disease affects
about 1% of the general population, and it has a great impact
on the patients’ quality of life leading to social isolation and
low self-esteem. The diagnosis, and thus proper treatment, is
often delayed and most patients have been given numerous
ineffective antibiotic treatments due to the misconception of
HS being an infectious disease. The cause of HS is still unclear
but hyperkeratosis and occlusion of the hair follicle, with
ensuing inflammation are considered important factors for
development of the disease. Genetic factors also seem to be of
importance and in some families specific gene mutations have
been found. The treatment of HS is often challenging but var-
ious anti-inflammatory agents (e.g. antibiotics as lymecycline
or rifampicin/clindamycin or biologics as adalimumab) can be
used, or an affected area can be excised by surgery or CO 2 -laser.
We started an outpatient clinic focused on patients affected
by HS 3 years ago at the Department of Dermatology and
Venereology, Skåne University Hospital in Lund. This work
was recently awarded with a grant (the SPIRA stipendium,
50.000 SEK). The patients in our clinic are, in addition to being
Forum for Nord Derm Ven 2017, Vol. 22, No. 2
treated with systemic medication and with CO 2 -laser surgery,
given opportunities to make lifestyle changes. Using this ho-
listic approach, we try to make a health plan for each patient
which we believe improves the compliance to the treatment.
A nurse-controlled outpatient clinic has also been initiated in
order to make the care more effective. The gained knowledge
is also mediated to regional GPs and other dermatologists
by lectures about HS. So far, we have developed a patient
information brochure about the disease and we are right now
working on a systemic treatment algorithm based on practical
experience and current literature. European guidelines on the
treatment of HS were published in 2014 and there have been
many publications about HS since then (1–3). It is a challenge
to work with HS and exciting to follow what happens in the
field of HS over the next years!
References
1. European Dermatology Forum S1 guideline 2014. http:/www.
euroderm.org/images/stories/guidelines/2014/Guideline-on-Hi-
dradenitis-suppurativa-S1.pdf.
2. Mikkelsen PR, Dufour DN, Zarchi K, Jemec GB. Recurrence rate and
patient satisfaction of CO2 laser evaporation of lesions in patients
with hidradenitis suppurativa: a retrospective study. Dermatol Surg
2015; 41: 255–260.
3. Kromann CB, Ibler KS, Kristiansen VB, Jemec GB. The influence
of body weight on the prevalence and severity of hidradenitis
suppurativa. Acta Derm Venereol 2014; 94: 553–557.
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